Manuel Michael R, Chen Lee-May, Caughey Aaron B, Subak Leslee L
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco (UCSF), San Francisco, CA 94143, USA.
Gynecol Oncol. 2004 Apr;93(1):1-8. doi: 10.1016/j.ygyno.2004.01.030.
To evaluate methodological quality and trends of cost-effectiveness analyses (CEA) published in gynecologic oncology.
A medical literature search of articles from 1966 through 2002 was performed to identify original, English-language articles that included economic analyses in gynecologic oncology. We included articles that were cost-effectiveness or cost-benefit analyses or performed these analyses as part of their study. Ten methodological principles that should be incorporated in CEAs were assessed for each study. Each article was given a score of 0, 1, or 2 for each of the 10 methodological principles (max score = 20). Data were analyzed using the Student t test, ANOVA, and linear regression.
We screened 693 articles to identify 68 that met our inclusion criteria. The articles focused on cervical cancer (n = 53; 78%), ovarian cancer (n = 11; 16%), uterine cancer (n = 2; 3%), and general perioperative care (n = 2; 3%). The mean (+/-SD) methodological principle score was 16.1 (+/-4.1) and we observed a significant improvement in the total score over time (P = 0.01). Primary CEA's (CEA identified as the objective of the study) were of higher quality than secondary CEA's (primary objective of the study was not CEA but CEA was included in the study; total scores 18.2 vs. 11.6, respectively; P<0.0001). Studies with at least one investigator in public health or healthcare economies also had higher quality (mean total score 17.7 vs. 15.2; P=0.006). The most common limitations of published CEAs were in methodology or presentation of incremental analyses, sensitivity analyses, and discounting.
Cost-effectiveness analyses in gynecologic oncology showed significant improvement in quality over the last two decades. Despite this progress, methodological improvement is still needed in the areas of incremental comparisons and sensitivity analysis. Understanding the methodology of cost-effectiveness analysis is critical for researchers, editors, and readers to accurately interpret results of the growing body of CEA articles.
评估发表于妇科肿瘤学领域的成本效益分析（CEA）的方法学质量及发展趋势。
检索1966年至2002年的医学文献，以识别妇科肿瘤学领域包含经济分析的英文原创文章。我们纳入了成本效益或成本效益分析文章，或在研究中进行了此类分析的文章。针对每项研究评估了应纳入CEA的十条方法学原则。每篇文章在十条方法学原则中的每项原则的得分分别为0、1或2（最高分=20）。使用学生t检验、方差分析和线性回归对数据进行分析。
我们筛选了693篇文章，确定了68篇符合纳入标准的文章。这些文章主要关注宫颈癌（n = 53；78%）、卵巢癌（n = 11；16%）、子宫癌（n = 2；3%）和一般围手术期护理（n = 2；3%）。方法学原则的平均（±标准差）得分为16.1（±4.1），并且我们观察到总分随时间有显著提高（P = 0.01）。原发性CEA（将CEA确定为研究目标）的质量高于继发性CEA（研究的主要目标不是CEA，但研究中包含CEA；总分分别为18.2和11.6；P<0.0001）。至少有一名公共卫生或医疗保健经济学领域研究人员参与的研究质量也更高（平均总分17.7对15.2；P = 0.006）。已发表CEA最常见的局限性在于增量分析、敏感性分析和贴现的方法或呈现方式。
过去二十年来，妇科肿瘤学领域的成本效益分析在质量上有显著提高。尽管取得了这一进展，但在增量比较和敏感性分析领域仍需要方法学改进。了解成本效益分析方法对于研究人员、编辑和读者准确解读越来越多的CEA文章结果至关重要。
